Last Name
First Name
Middle Initial
Current Address
City
State
Zip
Phone
Permanent Address
City
State
Zip

	Questionaire
	Are you 18 years or older?	YES    NO
	If hired, can you present evidence of your legal right to work in the United States? (The immigration Reform & Control Act of 1986 requires you to furnish proof of your employment authorization and identity before you can begin work.)	YES    NO
	Have you ever been convicted of a criminal offense (felony or misdemeanor)? (Convictions for marijuana related offenses that are more than two years old need not be listed.)	YES    NO
	If yes, state the nature of the crime(s), when and where convicted, and disposition of the case. (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Employment Desired
Position
Date You Can Start
Desired Salary
Are You Employed Now?	YES    NO
If Yes, May We Inquire Of Your Current Employer?	YES    NO
Ever Applied To This Company Before?	YES    NO
Where?
When?
Referred By

	Education
	Education Reached
	List Any Vocational Schools Attended
	List Any Professionl Or Vocational Certifications, Licenses Or Registrations That You Currently Hold Or Have Held
	Describe Any Specialized Training, Apprenticeship Skills, Extracurricular Activities, Honors, Scholarships, Appointments, Awards Or Special Recognition That You Have Received

	References
	Full Name (Reference #1)
	Company
	Phone Number
	Full Name (Reference #2)
	Company
	Phone Number
	Full Name (Reference #3)
	Company
	Phone Number

	Employment History
	Company Name
	Phone
	Position Held
	Pay/per hr
	Address
	Type of Business
	Supervisor's Name
	Reason For Leaving
	From
	To

	Additional Employment History
	Company Name
	Phone
	Position Held
	Pay/per hr
	Address
	Type of Business
	Supervisor's Name
	Reason For Leaving
	From
	To
	Upload Resume

	Availability
	Shifts	DAYS SWING GRAVEYARD TEMP TEMP-TO-HIRE
	Availability	FULL TIME PART-TIME WEEKENDS ONLY SHORT TERM
	How Did You Hear About Us?

I hereby affirm: The information in this application is true and accurate. If any of the following turns out to be false or misleading, Mainstay Business Solutions may dismiss me immediately in its sole discretion. If hired, I agree to provide documentation authorizing me to work in the United States. I authorize Mainstay Business Solutions to contact my worksite company for relevant information about me; and I authorize Mainstay Business Solutions to release the informtion herein, as reasonably required, to any client of Mainstay Business Solutions, or insurance company; and I authorize Mainstay Business Solutions to give future prospective employers relevant information about my employment, if so requested. I understand my employment may be conditioned upon my passing a physical examination, and/or a drug and alcohol test, and if hired, I agree to be subject to alcohol and drug testing for my safety and the safety of others; and in connection with any job-related injuries, as Mainstay Business Solutions deems necessary. I understand and agree that the terms and conditions set forth in the Mainstay Business Solutions policy manual(s), including those entitled "Harassment"; and others are incorporated herein and are a part of my employment, and that I have had the opportunity toreview the Polices, and fully understand and agree to them. Mainstay Business Solutions will manage your payroll, benefits administration and other areas. Since Mainstay Business Solutions is a tribally owned staffing company, it is a sovereign entity, which means that not all state and federal laws regarding employment are necessarily applicable. You are under no obligation to accept employment on these, or any other terms; and you are free to further investigate your rights, and any applicable laws at your own expense and on your own time. Please understand, however, that recognition and acceptance of the sovereign status of Mainstay Business Solutions is essential to your employment, and no services may be performed, and no wages paid unless and until you have indicated your understanding of and agreement to the foregoing matters by signing below. As an employee of the Blue Lake Indian Tribe (the "Tribe"), I consent to the exclusive jurisdiction of the Tribe's Grievance Process and the Tribal Court for any and all disputes in connection with my employment with the Tribe. I also consent to the application of the Tribe's Law, both substantive and procedural regarding any and all proceedings, and all matters relating to my employment relationship with the Tribe.